[Laparoscopic totally extraperitoneal repair of strangulated groin hernia]. / Laparoskopicheski assistirovannaya total'naya ekstraperitoneal'naya plastika (laparoscopic assistant total extraperitoneal plastic ­ latep) v lechenii ushchemlennykh gryzh pakhovoi oblasti.

OBJECTIVE: To study the possibility of totally extraperitoneal repair combined with diagnostic laparoscopy in the treatment of strangulated groin hernias (Laparoscopy-Assisted Totally Extraperitoneal Plasty, LATEP). MATERIAL AND METHODS: We analyzed the results of laparoscopic totally extraperitoneal hernia repair. The trocar placement technique was modified. There were 38 patients with strangulated groin hernia. The sample included 26 patients with strangulated inguinal hernia, 9 ones with strangulated femoral hernia and 3 patients with recurrent strangulated inguinal hernia. RESULTS: LATEP was attempted in 38 patients and successful in 37 (97.3%) cases. In 1 (2.6%) patient, correction of small bowel strangulation was failed and conversion to open surgery was required. In 29 patients (76.3%), correction of strangulation was performed after laparoscopy-assisted external manipulations and careful traction from abdominal cavity. In 8 (21%) cases, strangulation spontaneously regressed before laparoscopy. Laparoscopy confirmed viability of strangulated organs in 36 patients. One (2.6%) patient required bowel resection due to small intestine wall necrosis. Later, all patients underwent totally extraperitoneal repair. We were able to prevent the contact of hernia sac fluid with the implant in all cases. At the stage of preperitoneal repair, local damage to peritoneum occurred in 9 patients. Nevertheless, sealing was not required since hernia fluid was previously removed from abdominal cavity. There were no signs of implant infection and hernia recurrence within 6-14 months. CONCLUSION: Totally extraperitoneal repair combined with diagnostic laparoscopy is possible for strangulated groin hernias.

[Diagnostic and conservative treatment nuances in patients with obstructive jaundice: in the wake of Russian consensus].

The research was performed at the Loginov Moscow Clinical Scientific Center. It is based on Russian obstructive jaundice (OJ) consensus results, considered at the 45th annual Central Research Institute of Gastroenterology Scientific session Oncological issues in the gastroenterologist practice (1 March 2019). The article objective is to note the diagnostic and conservative treatment current issues in patients with OJ. The increase in the number of patients with OJ of different etiology provides problem actuality. In a large number of cases, medical treatment is delayed due to inadequate diagnostic and management, while correct patients routing today can be provided regardless of medical institution level. In this article the examination steps and conservative treatment role in patients with biliary obstruction management are presented.

[Open and laparoscopic surgery via minimally invasive approach in the treatment of perforated ulcer: a systematic review and metaanalysis]. / Laparotomnye i laparoskopicheski assistirovannye operatsii iz minidostupa v lechenii probodnoi yazvy. Sistematicheskii obzor i metaanaliz.

OBJECTIVE: Systematic review and metaanalysis of the effectiveness of open and minimally invasive laparoscopic suturing of perforated peptic ulcer. MATERIAL AND METHODS: Searching for Russian and English language reports included Scientific Electronic Library, Cochrane Collaboration Library and PubMed databases. We have analyzed contents of specialized journals, reviews and their references. Unpublished data were obtained via communication with chiefs of national surgical hospitals. RevMan 5.3 software was used for metaanalysis. RESULTS: We found no international randomized trials in available literature. Metaanalysis was based on national non-randomized studies. Total sample was 1177 cases. Laparoscopic minimally invasive surgery was performed in 43% of cases (n=503), open suturing - in 57% (n=674) of patients. Choice of these procedures is not currently not standardized. Minimally invasive procedures are shorter in time (mean difference -8.02, 95% CI -11.26 - -4.77, p<0.00001) and ensure less hospital-stay (mean difference -1.93, 95% CI -2.97 - -0.88, p=0.0003). Complications were less common (OR 0.14, 95% CI 0.07-0.27, p<0.00001) after minimally invasive operations (2.4%, 12/503) compared to laparotomy (11.4%, 77/674). Incidence of suture failure was similar (OR 0.4, 95% CI 0.1-1.6, p=0.2) (0.4% (2/503) vs. 0.7% (5/674)). Postoperative mortality was higher (OR 0.14, 95% CI 0.05-0.37, p<0.0001) after laparotomy (8%, 54/674) compared to laparoscopy (0.8%, 4/503). CONCLUSION: A metaanalysis indicates the advantage of laparoscopy-assisted suturing of perforated ulcer via minimally invasive approach over laparotomy. The absence of a standardized approach in choosing of minimally invasive laparotomy and conventional approach is a limitation of these results.

[Russian consensus on current issues in the diagnosis and treatment of obstructive jaundice syndrome]. / Rossiiskii konsensus po aktual'nym voprosam diagnostiki i lecheniya sindroma mekhanicheskoi zheltukhi.

The Russian consensus document on topical issues of the diagnosis and treatment of obstructive jaundice syndrome was prepared by a group of experts in various fields of surgery, endoscopy, interventional radiology, radiological diagnosis and intensive care. The goal of this document is to clarify and consolidate the opinions of national experts on the following issues: timing of diagnosis of obstructive jaundice, features of diagnostic measures, the need and possibility of conservative measures for obstructive jaundice, and strategy of biliary decompression depending on the cause and level of biliary block.

[Epidemiology and risk factors of adverse outcome in nonvariceal upper gastrointestinal bleeding]. / Épidemiologiia i faktory riska neblagopriiatnogo iskhoda pri nevarikoznykh krovotecheniiakh iz verkhnikh otdelov zheludochno-kishechnogo trakta.

AIM: To identify risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding. MATERIAL AND METHODS: Epidemiological observational analytical longitudinal retrospective cohort study included 312 patients who were hospitalized in the Clinical Hospital #40 of Yekaterinburg in 2014-2016. The main inclusion criterion was nonvariceal upper gastrointestinal bleeding. RESULTS: In-hospital mortality was 31 (9.9%) of 312 patients. Multivariate analysis confirmed the following risk factors of mortality: severity of blood loss (OR 22.70, 95% CI 5.08-102.00); open surgery (OR 15.20, 95% CI 2.71-74.80); M. Charlson comorbidity index (OR 2.15, 95% CI 1.34-3.43); risk of recurrent bleeding according to T. Rockall scale (OR 1.76, 95% CI 1.18-2.64). CONCLUSION: Independent risk factors of adverse outcomes in patients with nonvariceal upper gastrointestinal bleeding are severe hemorrhagic shock, open surgery, high M. Charlson comorbidity index and risk of recurrent bleeding according to T. Rockall scale.

[Laparoscopic rendezvous surgery for cholecystocholedocholithiasis]. / Laparoéndoskopicheskie vmeshatel'stva pri kholetsistokholedokholitiaze (tekhnika Rendezvous).

OBJECTIVE: To present a modified technique of laparoscopic surgery (Rendezvous technique) for cholecystocholedocholithiasis. MATERIAL AND METHODS: There were 41 patients with cholecystocholedocholithiasis who underwent hybrid single-stage laparoscopic surgery (Rendezvous technique) as an alternative to conventional two-stage approach. RESULTS: Two (4.8%) patients had elevated serum amylase level without signs of pancreatitis in postoperative period. Other 2 patients required redo transpapillary intervention due to residual stones. Laparoscopic interventions were successful in 95.2% of cases.

[The comparative analysis of laparoscopic and minilaparotomic techniques in emergency abdominal surgery].

Owing the experience of 16 101 miniinvasive operations by acute diseases of the abdominal cavity, the authors pose that the introduction of polytechnological methods has certain perspectives. The combination of different methods with the use of modern technologies lead to better results.

[Rapid diagnosis of purulent-destructive forms of acute calculous cholecystitis].

Results of examinations and treatment of 200 patients with acute calculous cholecystitis were analyzed. It is demonstrated that risk of purulent-destructive forms depends on nature of pathologic process in the gall bladder. Among patients with obstructive calculous cholecystitis 79.7% underwent surgery due to purulent-destructive forms of the disease, with non-obstructive calculous cholecystitis -- 38.9%. Risk of intraabdominal complications depends on the fact of obstruction of gallbladder neck and extrahepatic bile ducts. Algorithm of a rapid diagnosis was diagnosed. It permits to diagnose purulent-necrotic forms of acute calculous cholecystitis in 63.5% patients during 2 hours and in 85.7% patients during 6 hours from the time of hospitalization that ensures timely surgery.

[Minilaparotomy and "open" laparoscopic surgeries in treatment of patients with cholelithiasis]. / Minilaparotomiia i "otkrytye" laparoskopicheskie operatsii v lechenii bol'nykh zhelchekamennoi bolezn'iu.

The theoretical bases and techniques of an original method for operations on the abdominal organs and peculiarities of the instruments used are discussed. The results of treatment of 374 patients by "open" laparoscopic operations are shown. These were: cholecystectomy with intraoperative cholangiography, choledochotomy, choledocholithotomy, choledochostomy and formation of choledochoduodenostomy. The author claims that the method supplements the conventional laparoscopic and laparotomy method of transabdominal operations. It is suggested that such methods may prove valuable in urology and gynecology.

[A scale for estimating multiple organ dysfunction in surgical patients]. / Skala otsenki poliorgannoi disfunktsii u khirurgicheskikh bol'nykh.

A scale is proposed for estimating the severity of multiple organ dysfunction in surgical patients and its changes in the course of treatment. The scale was tried in 37 patients after abdominal operations. Estimations performed by means of the scale ore revealed good correlation with the patient's clinical status. Routine parameters are used in the scale, which facilitates its utilization in any surgical intensive care. The scale helps evaluate the severity of each system damage.

[Conservative treatment of hepaticocholedochus stones via external biliary fistulae]. / Konservativnoe lechenie bol'nykh s kamniami gepatikokholedokha cherez naruzhnye zhelchnye svishchi.

The experience with non-surgical treatment of retained stones in 13 patients is described. The treatment was successful in 8 cases. The method of dissolution of the stones and their mechanical removal with the help of a lithotrap of own design was used. The conclusion is drawn, that the treatment of the patients with gallstones in presence of external biliary fistulas should start from conservative methods.